D-Xylose, 5-hour Urine

Last Modified: 6/17/2019 10:50:47 AM


Medical Necessity Documentation:  
Client Notes: Please contact PHL Client Response at 266-1500 (Option 1) to schedule an appointment at PRMC


Patient Preparation:

Adults: Patients must be fasting for at least 8 hours (no food or fluids except water).
Infants: Fasting 4 hours

Specimen Requirements: 20.0 mL aliquot of a 5 hour Urine collection in a Plastic Container
Collection Instructions:
Have patient void and discard urine.
The patient is given 25 grams of d-Xylose dissolved in 250 ml of water followed by another 250 mls of water. Note time given.
No food or fluid is to be taken for the next five hours and only quiet activity allowed.
All urine passed within the next five hours is pooled. It is either preserved with sodium fluoride (NaF) (special urine container) or refrigerated during collection.
If not preserved it must be kept refrigerated until the volume is measured and an aliquot (minimum 20 ml) is removed and frozen.


For children 
0.5 gm of d-xylose/kg of body weight (divide lbs. by 2.2) up to 25 gms is given. The amount of water is also cut according to the patient's weight (5-10 g/100 ml water). Record dosage given on request slip if other than 25 gms.

Pour aliquot of total collection into a gray top fluoride oxalate blood collection tube
Minimum Volume: 1.0 mL
Transport & Storage: Temperature/Stability: Frozen
Reference Range: 5 gram dose: 1.2 - 2.4 g in 5-hr Urine
25 gram dose: 4.1 - 8.2 g in 5-hr Urine
Critical Ranges:  
Test Comments:  
Methodology: Coloimetric
Clinical Significance:  
Documentation:  
Custom Panel: No

PRODUCTION SCHEDULE

Turn Around Time: 3 to 6 days
Days Performed: Monday, Thursday
Sites Performed: Quest - Chantilly
PHL Test Code: XYLU
EPIC Test Code: LAB2516
Send Out Test Code: 11613 / 941X
Alternate Test Names: Xylose Absorption
Included Tests:  
CPT Coding: 84620

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